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皮肤冠状动脉干预后扩展的双对单抗血小板治疗:贝叶斯的元分析和对所有原因死亡率的回归

Faizan Ahmed¹, Faseeh Haider², Ramsha Ali³

¹Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, USA.

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

|November 26, 2025

概括

通过皮肤冠状动脉干预 (PCI) 后的双重抗血小板治疗 (DAPT) 与单一抗血小板治疗 (SAPT) 相比,增加了全因死亡率和出血事件. 由于相关的不良事件和死亡风险,扩展DAPT需要仔细考虑.

科学领域:

心脏病学和干预性心脏病学
药理学和治疗学药理学和治疗学
临床试验分析和元研究.

背景情况:

目前的指导方针建议在穿皮冠状动脉干预 (PCI) 后进行双重抗血小板治疗 (DAPT),但最优的持续时间和过渡策略 (例如,单一抗血小板治疗,SAPT) 仍在争论中.
关于扩展DAPT与SAPT的安全性和有效性的比较数据有限,特别是在死亡率和出血风险方面.

研究的目的:

评估双抗血小板治疗 (DAPT) 与经皮冠状动脉干预 (PCI) 后单抗血小板治疗 (SAPT) 的临床安全性.
评估潜在混因素对接受PCI的患者全因死亡率的影响.
为指导PCI后抗血小板治疗决策提供比较结果数据.

主要方法:

在主要数据库 (PubMed,Embase,Cochrane,ScienceDirect,Scopus) 进行了遵循PRISMA指南的系统文献搜索,直到2025年4月.
包括随机临床试验 (RCT) 和队列研究,使用贝叶斯随机效应元分析和元回归来分析.
评估的主要结果是全因死亡率和出血事件,次要结果包括净不良临床事件 (NACE) 和主要不良心脏和脑血管事件 (MACCE).

主要成果:

与单一抗血小板治疗 (SAPT) 相比,双重抗血小板治疗 (DAPT) 与全因死亡率 (OR 1.25) 的增加以及净不良临床事件 (NACE) 和各种出血事件 (轻微,重大,BARC 2-5) 的更高风险有关.
在心脏死亡,心血管死亡率,MACCE,心肌梗塞 (MI),支架血栓形成或中风方面,没有发现DAPT和SAPT之间的显著差异.
超回归表明,较高的基线风险对于疾病如失脂症,高血压,先前的MI和先前的再血管化与DAPT的较大死亡益处有关,但DAPT队列内的不良事件增加与较高的全因死亡率显著相关.

结论:

扩展双抗血小板治疗 (DAPT) 与单抗血小板治疗 (SAPT) 相比,与增加全因死亡率,出血事件和净不良临床事件 (NACE) 有关.
虽然DAPT在高风险患者群体中可能有好处,但与其相关的不良事件与死亡率有显著的相关性,因此需要经过PCI后仔细选择患者,监测和风险益处评估.
这些发现强调了在皮肤冠状动脉干预 (PCI) 后需要个性化的抗血小板策略.

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